1 Rehabilitation Following Meniscus Repair Alone & Combined with ACL Reconstruction Russ Paine, PT Director – Memorial Hermann Sportsmedicine Rehabilitation Houston, Texas Meniscus • Knee bends 2-4 million x per year • Forces = 4x body weight • Medial meniscus = translates between 2-5 mm (HSS) • Lateral meniscus = untethered = 9-11 mm. • Hoop stress = squeezes meniscus to periphery Meniscus Biomechanics • 1968 – Jackson – no function, exact function still matter of conjecture • Smiley = advocated complete removal • 1948 Fairbank suggested load- transmission function, complete removal = flattening femoral condyles, osteophyte formation • 1975 30-90% of load passes through meniscus Loading of Meniscus • Seedhom = 70-99% compressive load transmitted through menisci • Flexion past 75 degrees = 100% of load goes through posterior horn • 85% of tears in posterior horn • Meniscus removal = 50-70% reduction of contact area • ACL plus meniscus repair = aids healing, aggressive but extension ROM focus! Function of Meniscus Joint Stability • In the ACL deficient knee, removal of the medial meniscus = increased ATT • Lateral meniscus = minor ATT • Meniscus minor role in stability • Distraction forces less harmful than shear forces Meniscus Vascularity Arnoczky • Meniscus repairs dependent on location • Peripheral tears = increased vascularity • Henning – pioneered meniscus repair = used fibrin clot to help heal repair
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Rehabilitation Following Meniscus Repair rehabilitation of...Rehabilitation Following Meniscus Repair Alone & Combined with ACL Reconstruction Russ Paine, PT Director – Memorial
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1
Rehabilitation Following Meniscus
Repair
Alone & Combined with ACL
Reconstruction
Russ Paine, PT
Director – Memorial Hermann Sportsmedicine Rehabilitation
Houston, Texas
Meniscus• Knee bends 2-4 million x per year
• Forces = 4x body weight
• Medial meniscus = translates
between 2-5 mm (HSS)
• Lateral meniscus = untethered =
9-11 mm.
• Hoop stress = squeezes meniscus
to periphery
Meniscus Biomechanics
• 1968 – Jackson – no function, exact function still matter of conjecture